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Industry
Convenience Store
Gas Station Store
Wireless Mobile
Products
Prepaid Cards and Gift Cards
Mobile Dealer
Gaming Vouchers
Wireless
Meet the Team
Blog
Contact
Sign Up Now
Français
Now Prepay Retailer Application Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Store Information
-
Step
1
of 3
Store Contact
Store Contact First Name
*
First Name
Store Contact Last Name
*
Last Name
Type of Business
*
Sole Proprietorship
Corporation
Partnership
Store Name (Doing business as)
*
Company Legal Name
*
(Exactly as it appears on your business license)
Store Phone Number
*
Store Email Address
*
Email
Confirm Email
Store Address
Store Street Address
*
Address (Please include suite or unit number if required)
Store City
*
City
Store Province
*
AB
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Province
Store Postal Code
*
Postal Code
HST/GST Number
*
Do you have a PST/QST Number? (For applicants in BC, SK, MB & QC)
*
No
Yes
Please provide your PST/QST Number
*
By checking this box, I agree to add gift cards to my store and accept the $1.50 weekly fee.
*
Yes, $1.50 weekly fee
No, I only want to sell virtual products.
Please note that selecting "No" means you will not be enrolled in the gift card program and will not be able to sell gift cards. If you have any questions, please contact your Sales Representative.
Please choose a display for your Gift Cards
*
Floor Display (80 pegs) - Discounted Price: $50
I already have a counter display
I already have a floor display
I don’t want gift cards and don’t require a display
CLICK HERE TO VIEW OUR CARD DISPLAY.
How many pegs does your current display have?
*
Next
Owner's Name
Owner First Name
*
First Name
Owner Last Name
*
Last Name
Owner's Mobile Phone Number
*
Owner's Email
*
Email
Confirm Email
(Please note that this email will be used to sign the retailer agreement through Adobe Sign)
Owner's Home Address (Please provide the owner's residential address)
Owner Street Address
*
Address Line
Owner City
*
City
Owner Province
*
AB
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Province
Owner Postal Code
*
Postal Code
Owner's Date of Birth
*
Next
Store Billing Address
*
Same as Store Address
Same as Owners Home Address
Different from Store & Home Address
Owner accept Contact
Billing Address
Billing Street Address
*
Address Line
Billing City
*
City
Billing Province
*
AB
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Province
Billing Postal Code
*
Postal Code
Optional: Add Email Address for Billing:
Please confirm the date after which we can proceed with shipping, or the date you can receive shipments at your location. Once confirmed, we will arrange delivery to your store address.
*
Kindly note that if the shipment is refused or returned, non-refundable courier fees will apply.
Please provide any additional notes or information you'd like us to include as we set up your account.
Submit
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